Covid-19 revealed vulnerabilities in the global supply chain of common drugs. Photo / 123RF
Covid-19 revealed vulnerabilities in the global supply chain of common drugs. Photo / 123RF
Ministry of Foreign Affairs staff in India visited a locked-down pharmaceutical factory in Bangalore as part of a mercy dash to free and then chaperone to the airport New Zealand's Prozac supply.
The action in early April to secure the 50,000 blister packs of fluoxetine capsules followed alarm atthe Beehive as fears of Covid-related disruptions to the medicine supply chain started to crystallise.
On March 30 drug-buying agency Pharmac gave Health Minister David Clark notice under the "no surprises" policy that there was likely to be a "short-term shortage" of the drug - an antidepressant taken regularly by 76,000 New Zealanders - after Indian prime minister Narendra Modi ordered a no-notice lockdown the day before the drug shipment was due to depart the medicine factory.
Pharmac chief executive Sarah Fitt said prior to Covid-19 she had never needed to work with the Ministry for Foreign Affairs and Trade, and the all-of-government mercy mission meant public warnings of an impending Prozac shortage were quickly rescinded.
"That was quite hair-raising, but we got there in the end," she said.
Another possible shortage in New Zealand, of paracetamol, resulting from disruptions to both the Indian factory where the generic drug was manufactured and with ingredient suppliers in China, was resolved before stocks ran low, but shows the vulnerability of globalised supply chains.
"That's been a great learning, globally. In the 10-15 years since the last pandemic, the reliance on China - particularly for raw materials - has grown. But, as it turns out, the China shutdown didn't affect us as much as we feared. The bigger issue for us has been India, where 40 per cent of generic drugs are made," Fitt said.
Briefings obtained under the Official Information Act show in late March Fitt briefed director-general of health Ashley Bloomfield that one-fifth of Pharmac's drug suppliers were flagging potential Covid-related issues with supply over the coming weeks and months.
Fitt said this week that in the months since that briefing was prepared matters had not improved. Over a third of suppliers were signalling problems and the risk that further potential shortages would "likely" need to be managed by sourcing alternatives or tasking diplomats as drug-babysitters.
"Our message is that this is going to go through until the end of the year, and probably beyond," she said.
Dr Graeme Jarvis, chief executive of large pharmaceutical company umbrella group Medicines NZ, said while his members had resolved issues with their own supply chains and manufacturing facilities, distribution was problematic.
"Where the issues are is airfreighting but that's a global issue, and not unique to the pharmaceutical industry. That should be no surprise, because a lot of product comes via passenger planes and 96 per cent of passenger planes are grounded," he said.
"There are always drug shortages, for a variety of reasons. Will there be an increase because of Covid? I honestly can't get out my crystal ball," Jarvis said.
Health Minister David Clark said in a statement that Pharmac was working "tirelessly to secure ongoing supply" and had kept him well briefed on the crisis, but added: "This is a global pandemic, and there are constraints on drug supply in all countries."
Clark's statement said Pharmac had recently been given $35m in additional funding to cover increased costs caused by a Covid-related currency devaluation and increase in airfreight costs.
Health Minister David Clark. Photo / Mark Mitchell
Fitt said dealing with the alarming contraction of the air-freight market had also involved shifting transit to shipping where possible and working with Mfat, and other government agencies, to ensure medicine supply was prioritised on what limited flights remained.
"The airfreight issue has become very challenging, especially out of Europe. At the beginning there was no place for people to go. Now there's central co-ordination, to make clear that medicines have top priority, and make sure they're put on airplanes first," she said.
A further challenge for Pharmac came from human psychology. Despite the country in February hosting around four months of drug supplies in the country held by suppliers, wholesalers and retailers, the impending crisis saw an equivalent to the run in supermarkets on toilet paper.
One Pharmac briefing noted this behaviour was causing a "major strain on supply chains for community medicines" and led to pharmacies being instructed to dispense only one month of medication at a time.
This was followed by reports of some doctors writing multiple prescriptions for patients in order for use at different pharmacies. Fitt said she was looking at relaxing the one-month limit for pharmacies in the coming months, but was unimpressed by the prescription spammers.
"It was done with good intent, but I think they probably don't realise the effect it has on the supply chain," she said.
